A patient operated for lower segment uterine fibroid had an uneventful surgery. Post operatively the urine output staed to decrease, upto 20 ml/hr. Rapid IV fluid infusions were given with injlasix and output increased to 70 ml/hr. Urine was clear. Patient complained of flank pain which was gradually progressing. Most common cause of such presentation would be:
Correct Answer: Unilateral uretric injury
Description: Decreased urine post operatively and flank pain point towards uretric injury. Here flank pain usually suggests that ureter has been ligated and is causing proximal hydrouretronephrosis. Increase in urine output with fluid and Lasix is due to increased urine production and excretion from the normal ureter. Bladder injury would usually present with decreased output with hematuria or urinary leak from the vault or Management of post operative uretric injury: CT urogram and a urinalysis If obstruction is noted on CT scan, it is usually present near the ureterovesical junction. The immediate step is attempted passage of a stent through the ureter under cystoscopic guidance. If a catheter can be passed through the ureter, it should be left in place for at least 4 to 6 weeks, allowing sutures to absorb and the obstruction or kinking to release. If the catheter cannot be passed through the ureter, the best course is to perform abdominal exploratory surgery and repair the ureter at the site of obstruction. If an exploratory surgery cannot be performed immediately, a temporary percutaneous nephrostomy tube may be considered.
Category:
Gynaecology & Obstetrics
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